The fate of testicular salvage in spermatic cord torsion depends on the duration of ischemia and the degree of torsion. Even though spermatic cord torsion (SCT) can occur at any age, it is rarely reported in older patients. If the physician does not pay close attention to this unusual situation, the lack of suspicion for SCT may result in a missed or delayed diagnosis. We report a very uncommon case of missed SCT occurring in a 63-year-old man.
Delayed Diagnosis ; Humans ; Ischemia ; Middle Aged ; Spermatic Cord ; Spermatic Cord Torsion ; Testis

The purpose of this study was to investigate the operational characteristics of the contract-managed highschool foodservice and to analyze the factors to effect the menu price. The data was collected from 249 highschools in Seoul. The results are as follows; Those surveyed highschools were established as 1 national, 74 public, and 174 private institution. Highschools were classified as 176 academic, 66 vocational, and 7 specific purposed institution. Students were organized as 70 boys', 23 girls', and 41 coeducational highschools. Most highschool started contract-managed highschool foodservice from 1999 and the period of foodservice contract was most 3 years and the operation styles in food distribution were 96 classrooms, 105 dining halls and 17 classrooms combined dining halls. The scale of contract foodservice management companies was 63.1% small and medium and 36.9% large enterprises. The surveyed highschools had the average meal price 2,141 won per meal and they had 1,518 pupils on the register. The participating rate to the foodservice was 68.5%. The facilities investment cost of the contract foodservice management company was 179,204,230 won for private institutions and was 138,119,010 won for national&public institutions. The period of the contract was 3.22 years in private institutions, which was significantly higher than national&public institutions which showed 2.85 years. The commissary foodservice schools had higher facilities investment cost than conventional foodservice schools. Classrooms foodservice had higher participating foodservice rate than Dining halls. The investment cost for facilities showed high in order of girls', boys', and coeducational high schools, and the number on the register and the number participating in the foodservice showed high in order of boys', girls', and coeducational high schools. The number on the register showed the highest in academic and vocational schools, specific purposed institutions in sequence, and the number participating in the foodservice showed high in order of academic schools, specific purposed institutions and vocational. However, the participating foodservice rate showed high in specific purposed institution, academic and vocational schools in order, and the meal price, the investment cost for facilities showed high in specific purposed institution, academic and vocational schools in sequence. Regionally, the district south of Han river had the average meal price 2,266.13 won, which showed higher in the eastern part which had 2,033.33 won. The western part had the average investment cost for facilities of 233,331,060 won, and the central district 126,137,140 won. The number on the register showed 1845.68 in the eastern part and 1308.00 in Dong-Jak area, that had clear differences among areas. When the period of the contract went longer, the investment cost for facilities had a tendency to increase. The significant differences were existed among meal price, the investment cost for facilities, the number on the register, the number participating in the foodservice, and the participating foodservice rate. The investment cost for facilities had increased according to the number participating in the foodservice and the participating foodservice rate. And the large enterprises showed higher participating foodservice rate than the small and medium enterprises.
Costs and Cost Analysis ; Humans ; Investments ; Meals ; Pupil ; Rivers ; Seoul*

Addisons disease is relatively rare than secondary adrenal insufficiency and result from progressive adrenocortical destruction. The common causes are idiopathic autoimmune atrophy and tuberculosis of adrenal glands. It is generally regarded as incurable in the sense that substitution therapy is required for the rest of the patients life. We report a case of tuberculous primary adrenal insufficiency which was confirmed by biopsy. This case was treated with antituberculous medication and showen to have improved adrenocortical function after six months.
Addison Disease* ; Adrenal Glands ; Adrenal Insufficiency ; Atrophy ; Biopsy ; Humans ; Tuberculosis

PURPOSE: To evaluate the feasibility and usefulness of the waist circumference-to-height ratio (WHTR) in screening for obesity in Korean children and adolescents. METHODS: Data, including body mass index (BMI), waist circumference (WC), and height, were obtained from the national growth surveys for children and adolescents in 2005. The WHTR was calculated dividing WC by height in subjects 2~18 years of age. Overweight and obese were defined by BMI percentiles for age and gender. The receiver operating characteristic (ROC) analysis was performed to find out the optimal cutoff values of WHTR that matched BMI-determined overweight and obesity using the STATA program. The area under the curve (AUC), a measure of diagnostic power, of WHTR was compared to WC. The influence of age on WHTR was analyzed by the SAS program. RESULTS: The WHTR significantly decreased with age, and had less correlation with age in the 6~18-year-old age group than the 2~5-year-old age group. Furthermore, the WHTR also had less correlation with age than WC in the 6~18-year-old age group. The AUC of WHTR in identifying overweight and obesity was significantly higher than the AUC of WC in the 6~18-year-old age group. The optimal cutoff values were 0.51 in boys and 0.49 in girls for obesity, and 0.48 in boys and 0.47 in girls for overweight, with all having the AUC>0.9. The optimal cutoff values of WHTR had a higher sensitivity for diagnosing obesity than WC> or =90th percentiles. CONCLUSION: The WHTR is an easy, accurate, and less age-dependent index with high applicability in screening for obesity in children and adolescents.
Adolescent ; Area Under Curve ; Body Mass Index ; Child ; Humans ; Mass Screening ; Obesity ; Overweight ; Phenothiazines ; ROC Curve ; Waist Circumference

PURPOSE: To evaluate the feasibility and usefulness of the waist circumference-to-height ratio (WHTR) in screening for obesity in Korean children and adolescents. METHODS: Data, including body mass index (BMI), waist circumference (WC), and height, were obtained from the national growth surveys for children and adolescents in 2005. The WHTR was calculated dividing WC by height in subjects 2~18 years of age. Overweight and obese were defined by BMI percentiles for age and gender. The receiver operating characteristic (ROC) analysis was performed to find out the optimal cutoff values of WHTR that matched BMI-determined overweight and obesity using the STATA program. The area under the curve (AUC), a measure of diagnostic power, of WHTR was compared to WC. The influence of age on WHTR was analyzed by the SAS program. RESULTS: The WHTR significantly decreased with age, and had less correlation with age in the 6~18-year-old age group than the 2~5-year-old age group. Furthermore, the WHTR also had less correlation with age than WC in the 6~18-year-old age group. The AUC of WHTR in identifying overweight and obesity was significantly higher than the AUC of WC in the 6~18-year-old age group. The optimal cutoff values were 0.51 in boys and 0.49 in girls for obesity, and 0.48 in boys and 0.47 in girls for overweight, with all having the AUC>0.9. The optimal cutoff values of WHTR had a higher sensitivity for diagnosing obesity than WC> or =90th percentiles. CONCLUSION: The WHTR is an easy, accurate, and less age-dependent index with high applicability in screening for obesity in children and adolescents.
Adolescent ; Area Under Curve ; Body Mass Index ; Child ; Humans ; Mass Screening ; Obesity ; Overweight ; Phenothiazines ; ROC Curve ; Waist Circumference

The HELLP syndrome, which is characterized by hemolysis, elevated liver enzymes and low platelets, complicates 4 to 14% of preeclamptic or eclamptic pregnancy. Its course is usually benign except when spontaneous hepatic rupture, a rare catastrophic event, threatens life. The authors have experienced one case of spontaneous hepatic rupture in HELLP syndrome during immediate postpartum period, which was treated with surgical intervention on the first postpartum day. We report this case with a brief review of the literatures.
Female ; HELLP Syndrome* ; Hemolysis ; Hemorrhage* ; Liver ; Postpartum Period* ; Pregnancy ; Rupture*

The role that antioxidants play in the process of carcinogenesis has recently gained considerable attention. alpha-Lipoic acid, a naturally occurring disulfide molecule, is a powerful antioxidant that reportedly exerts beneficial effects in patients with advanced cancer by reducing the level of reactive oxygen species and increasing glutathione peroxidase activity. In this study, we examined changes in the protein and mRNA expression associated with cell proliferation and apoptosis in MDA-MB-231 breast cancer cultured in the presence of various concentrations (0, 250, 500, and 1000 micromol/L) of alpha-lipoic acid. The results revealed that alpha-lipoic acid inhibited the growth of breast cancer cells in a dose-independent manner (P < 0.05). Additionally, ErbB2 and ErbB3 protein and mRNA expressions were significantly decreased in a dose-dependent manner in response to alpha-lipoic acid (P < 0.05). Furthermore, the protein expression of phosphorylated Akt (p-Akt) levels and total Akt, and the mRNA expression of Akt were decreased dose-dependently in cells that were treated with alpha-lipoic acid (P < 0.05). Bcl-2 protein and mRNA expressions were also decreased in cells that were treated with alpha-lipoic acid (P < 0.05). However, Bax protein and mRNA expressions were increased in cells treated with alpha-lipoic acid (P < 0.05). Finally, caspase-3 activity was significantly increased in a dose-dependent manner in cells treated with alpha-lipoic acid (P < 0.05). In conclusion, we demonstrated that alpha-lipoic acid inhibits cell proliferation and induces apoptosis in MDA-MB-231 breast cancer cell lines.
Antioxidants ; Apoptosis ; bcl-2-Associated X Protein ; Breast ; Breast Neoplasms ; Caspase 3 ; Cell Line ; Cell Proliferation ; Glutathione Peroxidase ; Humans ; Reactive Oxygen Species ; RNA, Messenger ; Thioctic Acid

Teratomas of the fallopian tubes are very rarely encountered in the western literature, and not a single case has been documented in Korea. The authors experienced two cases of tubal teratomas. Both patients developed a teratoma in an ampullary portion of the right fallopian tubes. One case occured as an incidental finding, and the other case was presented with a tubal mass. The gross and light microscopic features of these teratomas were described, and a brief review of the literature on the tubal teratomas is made.

PURPOSE: This study evaluated the extent of damage due to hypothermia in the mature and immature brain. METHODS: Hippocampal tissue cultures at 7 and 14 days in vitro (DIV) were used to represent the immature and mature brain, respectively. The cultures were exposed at 25degrees C for 0, 10, 30, and 60 minutes (n=30 in each subgroup). Propidium iodide fluorescent images were captured 24 and 48 hours after hypothermic injury. Damaged areas of the cornu ammonis 1 (CA1), CA3, and dentate gyrus (DG) were measured using image analysis. RESULTS: At 7 DIV, the tissues exposed to cold injury for 60 minutes showed increased damage in CA1 (P<0.001) and CA3 (P=0.005) compared to the control group at 48 hours. Increased damage to DG was observed at 24 (P=0.008) and 48 hours (P=0.011). The 14 DIV tissues did not demonstrate any significant differences compared with the control group, except for the tissues exposed for 30 minutes in which DG showed less damage at 48 hours than the control group (P=0.048). In tissues at 7 DIV, CA1 (P=0.040) and DG (P=0.013) showed differences in the duration of cold exposure. CONCLUSION: The immature brain is more vulnerable to hypothermic injury than the mature brain.
Animals ; Brain ; Dentate Gyrus ; Hippocampus ; Hypothermia, Induced* ; Neurons* ; Propidium ; Rats*

PURPOSE: Feeding intolerance is common in premature infants. It may extend the parenteral nutrition period and increase the risk of complications. We evaluated the efficacy of erythromycin and metoclopramide in neonates with feeding intolerance. METHODS: Between December 2006 to August 2011, 114 neonates with feeding intolerance were divided into two groups treated with either erythromycin or metoclopramide in the neonatal intensive care unit of Chung-ang University Hospital, a tertiary care center. We defined neonates with feeding intolerance as those who either could not be fully fed enterally (120 mL/kg/day) within 7 days or who skipped feeding more than twice per day because the gastric residual volume was >20% of each feed or more than 50% once. The time taken to achieve 50%, 75%, and 100% enteral feeding was estimated retrospectively. RESULTS: The erythromycin group achieved 50% feeding (P=0.047), 75% feeding (P=0.042), and 100% feeding (P=0.039) earlier than the metoclopramide group. The erythromycin group achieved 100% feeding earlier than the metoclopramide group among infants with birth weight > or =1,500 g (P=0.036) and those with gestational age > or =34 weeks (P=0.008). CONCLUSION: Compared with metoclopramide, erythromycin improves feeding in neonates with feeding intolerance, especially in infants with birth weight > or =1,500 g and in those with gestational age > or =34 weeks.
Birth Weight ; Enteral Nutrition ; Erythromycin* ; Gestational Age ; Humans ; Infant ; Infant, Newborn* ; Infant, Premature ; Intensive Care, Neonatal ; Metoclopramide* ; Parenteral Nutrition ; Residual Volume ; Retrospective Studies ; Tertiary Care Centers